Drug | Possible effects | Precautions |
Aluminum hydroxide gel | Decreased beta-blocker adsorption and therapeutic effect | Avoid beta-blocker-aluminum hydroxide combination |
Aminophylline | Mutual inhibition | Observe patient's response |
Amiodarone | May induce cardiac arrest | Combination should be used with extreme caution |
Antidiabetic agents | Enhanced hypoglycemia; hypertension | Monitor for altered diabetic response |
Calcium channel inhibitors (verapamil, diltiazem) | Potentiation of bradycardia, myocardial depression, and hypotension | Avoid use, although few patients show ill effects |
Cimetidine | Prolongs half-life of propranolol | Combination should be used with caution |
Clonidine | Hypertension during clonidine withdrawal | Monitor for hypertensive response; withdraw beta blocker before withdrawing clonidine |
Digitalis glycosides | Potentiation of bradycardia | Observe patient's response; interactions may benefit angina patients with abnormal ventricular function |
Epinephrine | Hypertension; bradycardia | Administer epinephrine cautiously; cardioselective beta blocker may be safer |
Ergot alkaloids | Excessive vasoconstriction | Observe patient's response; few patients show ill effects |
Glucagon | Inhibition of hyperglycemic effect | Monitor for reduced response |
Halofenate | Reduced beta-blocking activity; induction of propranolol withdrawal rebound | Observe for impaired response to beta blockade |
Indomethacin | Inhibition of antihypertensive response to beta blockade | Observe patient's response |
Isoproterenol | Mutual inhibition | Avoid concurrent use or choose cardiac-selective beta blocker |
Levodopa | Antagonism of levodopa's hypotensive and positive inotropic effects | Monitor for altered response; interaction may have favorable results |
Lidocaine | Propranolol pretreatment increases lidocaine levels with potential toxicity | Combination should be used with caution; use lower doses of lidocaine |
Methyldopa | Hypertension during stress | Monitor for hypertensive episodes |
MAO inhibitors | Uncertain, theoretical | Manufacturer of propranolol considers concurrent use contraindicated |
Phenothazines | Additive hypotensive effects | Monitor for altered response, especially with high doses of phenothiazines |
Phenylpropranolamine | Severe hypertensive reaction | |
Phenytoin | Additive cardiac depressant effects | Administer IV phenytoin with great caution |
Quinidine | Additive cardiac depressant effects | Observe patient's response; few patients show ill effects |
Reserpine | Excessive sympathetic blockade | Observe patient's response |
Rifampin | Increased metabolism of beta blockers | Observe patient's response |
Smoking | Increased metabolism of beta blockers | Observe patient's response |
Tricyclic antidepressants | Inhibits negative inotropic and chronotropic effects of beta blockers | Observe patient's response |
Tubocurarine | Enhanced neuromuscular blockade | Observe response in surgical patients, especially after high doses of propranolol |
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